Chronic obstructive pulmonary disease (COPD) is a disease state characterized
by airflow limitation that is not fully reversible. COPD is the fourth leading
cause of death worldwide and it is largely preventable. The main cause in
developed countries is exposure to tobacco smoke. Other preventable causes
include exposure to indoor and outdoor air pollution, such as occupational
exposure (firefighters, farm workers) and the burning of biomass fuel for
cooking and heating which impacts many women in Africa, China, and India.

In 2010, COPD was estimated to account for 2.7% of the disease burden and
3.2% of deaths in Europe, and for 3.1% of the global disease burden and 5.5% of
deaths worldwide. 3,4 Worldwide prevalence of "moderate" COPD estimated by the
Global Initiative on Obstructive Lung Disease (GOLD) in adults aged 40 years and
older is 9–10%. Stage III COPD (generally considered as "severe") drives most of
the costs of COPD. Its prevalence across 12 sites around the glove ranged from
0.8% (Hannover, Germany) to 6.7% (Cape Town, South Africa) The Burden of
Obstructive Lung Disease initiative used standardized methods to investigate the
prevalence of COPD around the world and showed important differences between
countries. Prevalence ranged from 9% in Reykjavik, Iceland to 22% in Cape Town,
South Africa, for men, and from 4% in Hannover, Germany to 17% in Cape Town for
women.

Chronic obstructive pulmonary disease is associated with major morbidity and
mortality such as cardiovascular disease, muscle wasting, type 2 diabetes, and
asthma. Smoking cessation will probably have the most important effects on COPD
as a public health problem in Europe and the world as it slows disease
progression and lowers mortality.

None of the existing medications for COPD has been shown to modify the
long-term disease progression such as decline in lung function in many patients
or worsening of health status. Therefore, pharmacotherapy for COPD is used to
alleviate symptoms and/or prevent complications. Inhaled bronchodilators are the
mainstay treatment for COPD. Two large-scale, long-term, landmark studies have
confirmed the efficacy of a fixed dose combination of a long-acting β2 agonist
(salmeterol) and inhaled corticosteroid (fluticasone) and a long-acting
anticholinergic agent (tiotropium).

Substantial unmet needs remain in COPD preventing the progression of COPD.
Drug development for COPD is difficult owing to the chronic and slowly
progressive nature of the disease. Not a single new therapy has come from
information on pathogenic inflammatory processes. What is needed are surrogate
markers of inflammation that may predict the clinical usefulness of new
management and prevention strategies for COPD, new clinical end points to assess
the impact of different COPD interventions and standardized methods for tracking
trends in COPD prevalence, morbidity, and mortality over time.

New medicines for the treatment of COPD are greatly needed and there has been
an enormous effort now invested by the pharmaceutical industry to find such
treatments. While preventing and quitting smoking is the obvious preferred
approach, this has proved to be very difficult. Not all COPD is due to cigarette
smoking, especially in low- and middle-income countries (LMIC).